Organization
ANASAZI DENTURE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN CAIN CDT, LD, DN (PRESIDENT)
(480) 471-9560
Entity
Organization
Contact information
Practice address
18425 E STIRRUP LN, RIO VERDE, AZ 85263-7114
(480) 471-9560
Mailing address
P.O.BOX 111, DAYTON, WA 99328
(480) 650-4234
(480) 471-3089
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN60082396
WA
302F00000X
Exclusive Provider Organization
DN60082396
WA
Other
Enumeration date
01/20/2010
Last updated
01/20/2010
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